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Reduction in mortality associated with statin therapy in patients with severe sepsis.
Pharmacotherapy 2009 June
STUDY OBJECTIVE: To evaluate the effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) on mortality in patients with severe sepsis.
DESIGN: Retrospective cohort study.
SETTING: Intensive care unit (ICU) of an academic medical center.
PATIENTS: One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006.
MEASUREMENTS AND MAIN RESULTS: Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality.
CONCLUSION: The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.
DESIGN: Retrospective cohort study.
SETTING: Intensive care unit (ICU) of an academic medical center.
PATIENTS: One hundred eighty-eight patients aged 40 years or older with a diagnosis of severe sepsis and an ICU stay between January 1, 2005, and December 31, 2006.
MEASUREMENTS AND MAIN RESULTS: Patient demographic data, statin use, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the time of sepsis diagnosis were collected from the patient database. We used a multivariable logistic regression model to evaluate the association between statin use and in-hospital all-cause mortality after controlling for age, sex, and severity of illness. Of the 188 patients who met our inclusion criteria, 60 (32%) had statin exposure. Patients receiving statins were similar in age, sex, and APACHE II scores to those not receiving statins. In the univariable comparison, the statin group had a 35% relative reduction in mortality compared with the nonstatin group (mortality rate 31.7% vs 48.4%, p=0.040). Most of the mortality reduction attributed to statins occurred in patients with APACHE II scores higher than 24 (mortality rate 32.3% vs 57.5%, p=0.031), with a minimal mortality difference in patients with APACHE II scores of 24 or lower (31% vs 36.4%, p=0.810). In the multivariable regression model, statin use had a protective effect (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21-0.84, p=0.014), whereas increasing age (OR 1.03, 95% CI 1.01-1.06, p=0.013) and higher APACHE II score (OR 1.11, 95% CI 1.05-1.18, p=0.001) were associated with increased mortality.
CONCLUSION: The use of statins was associated with a protective effect in patients with severe sepsis, as demonstrated by a significant reduction in mortality compared with patients not receiving statins.
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